The pandemic is not over yet
As masks significantly reduce transmission, large parts of society could wear them
US Vice President Mike Pence says America is well positioned to handle the “second wave” of coronavirus infections. This is nonsense — not least because much of the US has not yet confronted the first wave.
The surge of infections that marked the early pandemic in the Northeast has been delayed elsewhere by some combination of early action (as is plausibly the case in much of California) or because those places are more sparsely populated, more car-dependent and less reliant on public transportation or, bluntly, just luckier.
Many places haven’t seen a super-spreading event — yet.
Imagine if the president were to don a mask today, signalling to the whole country that they should follow suit, and the economy came roaring back without a corresponding tidal wave into the ICUs. This is surely a better option for everyone. A slowed economy is better than an utterly halted one
We epidemiologists do expect places like New York City, where introductions of the virus and contact rates are both high, to be especially vulnerable early on. Elsewhere, though, cases have built at a slower pace.
That may also partly be due to human reactions to the situation in the Northeast, or simply to different contacts occurring at different rates in different places with different climates. All in all, not terribly surprising.
Arithmetic of infection
But sadly, the arithmetic of infection is such that we do expect the pandemic to find its way to most places eventually — and certainly to those places that are not guarding against it. And when it gets there, it will do what it’s done elsewhere and transmit as much as it can, whatever the consequences for us.
The federal government seems, astonishingly, to have given up the fight. Even after over 116,000 deaths, there is nothing to see here, apparently. A few months back, we despaired at the failures in testing, in messaging, in action while Americans sickened and died.
In the spring, the federal pandemic response was akin to bringing a rubber chicken to a gunfight. The attempt to defend against the greatest threat to public health in a century was limp, grudging and delayed. Now it is barely existent. They’ve taken their rubber chicken to play elsewhere.
The lessons left lying unearned are staggering; citizens are being hit with bills for coronavirus testing, when testing is a pure and simple public good for everyone. (It is not, as President Donald Trump seems to believe, a “double edged sword” that “makes us look bad.”)
If you take a test and it’s positive, then you should isolate and preserve others from the long consequences of the transmission chains you might kick off.
Responsibly distanced
If it is negative, you should be confident carrying on in your life — responsibly distanced, of course, in case the test result was wrong or in case you get infected later. But if the test is free, there’s no downside to getting it.
If this sounds like free testing could get expensive, please look at the cost of not testing. We paid that cost all spring.
Look at the reviled shutdowns; they are the consequence of letting unknown amounts of infection build among your people until the only thing you can do to save lives is to call a halt to everything.
In some places, even then, people keep dying for months because it happened too late. In others, cases don’t climb and deaths remain low, because infection rates were lower when the intervention was made.
Somehow both examples become evidence for sceptics to argue that shutdowns don’t work, when it is plain that denying the virus opportunities for transmission is our best option.
Inaction presents a risk to the economy, and the sooner people accept that, the better. Shutdowns are less likely to be necessary again, and they’ll be shorter when they are, if milder steps are adopted early on.
If masks significantly reduce transmission, and it looks like they do, then large parts of society could get closer to normal, really soon.
It might seem a restriction on your freedom to wear a mask, but it’s a far smaller restriction than a shutdown — and in any case, your freedom to choose not to wear a mask conflicts with the freedom of others not to be infected by you.
Imagine if the president were to don a mask today, signalling to the whole country that they should follow suit, and the economy came roaring back without a corresponding tidal wave into the ICUs. This is surely a better option for everyone. A slowed economy is better than an utterly halted one.
None of this should be political, and yet somehow it is. The hyperpartisan nature of American society has taken a virus and fashioned from it a new battleground for the culture wars.
I should not be surprised at the way the pandemic has become politicised, and yet I am. It suggests that I was somehow less cynical than I had thought I was, and I thought I was pretty darned cynical.
Systemic racism
The politics may have been exacerbated by some of the epidemiology of the early pandemic, which has seen the risk of infection and death track closely with socioeconomic status and race. Exactly how much of these vulnerabilities are down to the existing systemic racism in American society isn’t clear, but it surely contributes.
We expect vulnerable people to put themselves at risk of severe illness or death while the more fortunate pretend the pandemic does not apply to them. Yet we are early on in the pandemic; there’s a long way to go, and middle-class folks likely don’t live in communities with much immunity.
While the rest of the US can perhaps make up a story in which disease happens in New York, because of whatever excuse confirms their prior beliefs, it’s harder to pretend it won’t be a problem if you look at the range of places the virus has done its deadly work.
Wuhan, China (now a relative success story!), Iran, Italy, Spain, the United Kingdom and New York. In May, Sweden was posting the highest per capita mortality rates (which have since declined), but now Brazil is surging.
But if your community has not experienced infection so far and it’s doing nothing to stop it, please ask yourself, do you feel lucky? Rich people living in the right place can imagine the pandemic is a problem for other people — but only for now.
The sad thing is that the virus doesn’t care about any of this. The virus will carry on infecting, transmitting, devastating organs and futures here and killing there, all without malice.
Viruses don’t do malice; that’s a human trait. Humans are, furthermore, capable of a degree of incompetence which is functionally indistinguishable from malice.
In one of the essays he wrote before he found fame with “1984” and “Animal Farm,” George Orwell declared that “to see what is in front of your nose requires a constant struggle.” There’s a pandemic under our nose. It’s not going anywhere.
William Hanage is an associate professor of epidemiology at the Centre for Communicable Disease Dynamics at the Harvard T.H. Chan School of Public Health.
Washington Post